目的 研究兔膝骨性关节炎(OA)早期软骨下骨血管再生变化及二磷酸盐的保护作用.方法 60只新西兰大白兔随机分成模型组(A组,24只)、二磷酸盐组(B组,24只)和对照组(C组,12只).术后4周、8周、12周处死兔子,切取手术侧膝关节,进行大体评分及Mankin评分,免疫组化染色测量骨软骨连接处的血管密度.结果 与C组相比,A组4周时已出现软骨退变(P＜0.01),8、12周时退变进一步加重(P＜0.01),并且骨软骨连接区血管侵犯的密度增加(P＜0.01);而B组的软骨退变轻于A组(P＜0.05或P＜0.01).结论 OA早期关节软骨开始退变,软骨下骨与关节软骨交界区血管增生.二磷酸盐对关节软骨有明显的保护作用.

目的：对老年股骨粗隆间骨折患者应用股骨近端髓内钉固定的临床效果进行分析。方法选取2011年3月至2013年3月我院收治的60例股骨粗隆间骨折患者，随机的将所有患者分成观察组与对照组，两组均有30例患者，观察组患者采取股骨近端髓内钉固定进行治疗，对照组患者采取动力髋螺钉进行治疗，将两组患者的并发症、出血量、功能恢复情况等进行对比。结果在住院时间、手术时间、出血量、并发症以及患者的功能恢复方面，将两组进行对比，P＜0.05，其差异具有统计学意义。结论对于老年股骨粗隆间骨折患者来说，采取股骨近端髓内钉固定的方式，临床治疗效果比较理想，具有较高的安全性。

Objective To observe the three-dimensional structure changes of subchondral bone in early stage knee joint instability and the effect of diphosphonate intervention so as to test the role of early three-dimensional structure changes of subchondral bone in pathogenesis of osteoarthritis (OA).Methods Sixty healthy male New Zealand white rabbits were assigned to model group (n =24),diphosphonate group (n=24) and control group (n =12) according to random number table.Rabbit right knee destabilization (anterior cruciate ligament transection) is used to induce OA.Rabbits in diphosphonate group received subcutaneous injection of 0.01 mg/kg diphosphonate (risedronate) per day.Instead,isotonic saline solution of the same volume was subcutaneously given to rabbits in model and control groups.One third of the animals in each group were killed at week 4,8 and 12 respectively.Surgical knee joint with preservation of each 2 cm bone above and below joint surface was dissected to perform Micro-CT.Bone volume fraction (BVF),trabecular thickness (Tb.Th),trabecular spacing (Tb.Sp),trabecular number (Tb.N),volumetric bone mineral density (vBMD) and tissue BMD (tBMD) were measured and analyzed statistically.Results At week 4 following operation,BVF,Tb.N and Tb.Th were lowered significantly in model group as compared to control group (P ＜0.01) ;BVF was lower in model group than in diphosphonate group (P ＜ 0.05) and lower in diphosphonate group than in control group (P ＜ 0.05) ; Tb.Sp was increased in model group as compared to diphosphonate group and control group (P ＜0.01) and had obvious increase in diphosphonate group as compared to control group (P ＜0.01) ; vBMD was significantly lower in model group than in diphosphonate group and control group (P ＜ 0.05),but there was no statistical difference between diphosphonate group and control group.At week 12 following operation,model group presented higher BVF,Tb.Th and Tb.N (P ＜0.05),significantly lower Tb.Sp (P ＜ 0.05) and significantly higher vBMD (P ＜ 0.01) as compared to diphosphonate group and control group.Conclusions In knee joint instability,variations of subchondral bone are mainly characterized by osteoclasia in the early stage,followed by osteogenesis in later stage.Diphosphonate may improve the bone architecture of subcondral bone via inhibition of bone resorption.

Objective To discuss the select of treatment,time of surgery and prevention of complications for type Ⅲ Pilon fractures.Methods Follow-up were done for 31 patients with Pilon fracture who had been treated in our department during April 2003 and July 2009.Their average age was 36.3 years(ranging from 21 to 64 years).6 cases were open fracture,and 25 cases were closed fracture.23 cases were accompanied with fibular fracture.23 cases of tibiae fracture fixed with plate,6 cases were treated with limited internal fixation with screw and Kirschner wire,2 cases were treated with the external fixators combined with limited internal fixation.Results With the 6～22 months follow-up after the operation(average 12 months).According to Mazur's criteria,the result was evaluated as excellent in 3 cases,good in 23 cases,fair in 3 cases and poor in 2 cases.The excellent and good recovery rate was 83.87%.Conclusion Many factors can affect the prognosis of complicated Pilon fracture,the key points for a successful operation are careful assessment of the injury,right treatment and timing of surgery,and practice after operation.

目的探讨四肢骨折脱位合并周围血管损伤的早期诊治。方法应用显微技术,及时修复血管,重建血运,保存肢体。结果本组37例患者无死亡,疗效较佳。患肢功能评定采用Johner-Wruhs评分法:优8例,良24例,可4例,差1例,优良率为86.49%。结论四肢骨折脱位合并血管损伤早期正确诊断及治疗意义重大。

Objective This experiment studied the change of amino acids in brain areas in rat after thoracic spinal cord transverse damage.Methods The levels of glutamic acid and glycine of hippocampus,striatum,hypothalamus in rat brain of experiment group,false operation group and normal control group were measured after 2h and 3d of traumatism.Results Both amino acid level of experment animals 2h and 3d dropped after injury.The glycine level in striatum and hypothalamus reduced more significantly 3d after injury.Conclusion The present finding suggets that spinal cord damage might influence brain aminoacids level significantly.